What is Beverly Hills Plastic Surgeon, Dr Randal Haworth’s, latest tool to minimize bruising with injections?
Injection techniques to place filler into the face to correct lines, folds and wrinkles have became even more advanced with the use of blunt tip cannulae, such as Dermasculpt.
These are similar to needles except that they are not sharp and therefore are less prone to cut the tiny diameter blood vessels in and below the skin.
What does this mean for the patient?
-Markedly less bruising
-Generally significant less discomfort
-Greater safety profile
I don’t employ them to treat all areas of the face, since certain anatomical facial features require extremely precise placement of filler not afforded by blunt tip cannulae. They are ideal to inject larger areas which require generalized plumping or filling such as the temples, cheek hollows, brows and jawline.
I have injected most types of filler through them including Juvederm, Restylane, Belotero, Artefill, Aquamid and Radiesse.
Be prepared to hear some minor crackling noise, however, for the first minute or so similar to lettuce being cut!
Over the last 3 to 4 years I, as a primary and revision rhinoplasty specialist, have noticed an increasing and disturbing trend being practiced amongst those facial and classic plastic surgeons in my immediate community of Beverly Hills and other cities. This trend revolves around the use of rib grafts for not only revision but also primary rhinoplasty (!) (or in common parlance, nose job).
A good number of rhinoplasties require cartilage in order to achieve exemplary results. Cartilage is used to either build a bridge, fill depressions, augment or support the nasal tip. It is mainly harvested from the septum (that partition that exists in the midline of the nose which separates the left and right nostril) or the ear. Though I am fully trained general surgeon and am comfortable operating in and around the lungs and heart, I rarely employ rid graft as a source of cartilage. For most, it is generally a last resort when absolutely no other cartilage source is available. Admittedly, rib provides a strong support and is generally in plentiful supply. However, a number of downsides arise when rib is harvested: a permanent visible scar is created below the breast. Additionally, significant pain can arise from the harvesting as well as a small chance of creating a pneumothorax (or a collapsed lung) . Finally, rib can be notorious for warping thereby creating a nose that is crooked. Despite these drawbacks, I will use rib when there is a collapsed nasal septum (or dorsum creating a saddle nose deformity) or when plentiful cartilage is needed while other sources are exhausted.
See the accompanying photos.
|I always use cartilage to highlight and augment the nasal tip, however, when there is not enough cartilage present and I only need to build the bridge by a small amount, I do not hesitate to employ some artificial material such as Goretex®. I utilize this only when the chance of infection is remote. When patients are properly selected for utilizing Goretex®, the chance of infection extremely minimal in my experience. Unfortunately, the surgeons who habitually use rib grafts will scare the bejesus out of their patients into choosing the rib graft method by overstating the chance of infection and poor outcome if Goretex® is used.
So if I am writing that rib grafts are over utilized, then why do the rib graft cartel tell their patients otherwise?
I feel it is simply a matter of finance. When a rib graft is harvested, the surgeon can charge a lot more for both his services and the operating room, especially if insurance is billed. Most patients will not question their surgeon’s motivated choices and indeed, feel that they have no choice at all, believing that the rib-graft-mafia method is their only solution.
What is especially unsettling is that these doctors who are members of the rib graft cartel are now utilizing rib grafts for primary rhinoplasties (first time nose jobs). This is very puzzling because there is plenty of prime cartilage graft material available from the septum and ear and there is little to no reason to subject the patient to a rib surgery.
All I can say is that this is a dangerous trend which introduces unnecessary risk and morbidity to the operation.
A good patient is an educated patient and the purpose of my blog is to merely propagate information in the most objective way possible so that patients can make their own decisions as sentient adults. To learn more about primary and revision rhinoplasty , you can click here.
Dr Randal Haworth
Beverly Hills, California
This lesser known anatomic point of the nose is often purposely overlooked by rhinoplasty specialist surgeons because of the challenges it poses to those attempting to alter it. It is represented by the angle formed by the uppermost portion of the nose as it blends into the forehead proper. Yes, altering this area does have a subtle, yet profound influence upon the final appearance of a nose job- it can differentiate an excellent result from a “so-so” one. The surgeon can raise the radix so that the nose blends into the forehead at a higher latitude as well as softly elevate the natural valley that can exist at this are if it is too deep. Furthermore, one can deepen the radix if too much bone is present between the eyeball and the bridge on profile view.
The ideal position of the radix lies approximately at the latitude of the upper eyelash/upper eyelid crease. Beverly Hills plastic surgeon, Dr Randal Haworth can raise it by placing a precisely shaped softened cartilage graft (usually harvested from the nasal septum or ear) with beveled edges onto the bone of the radix area. Alternatively the radix or nasion can be rasped or chiseled with specialized delicate instruments to a lower, deeper position.
Why does raising a radix from a low position improve the final appearance of a nose? Well, imagine two noses which are identical in shape and forward projection except that one has a low radix while the other has a high one. The one with the low radix is shorter compared to the one with the high. Now imagine two men, both with the same 34 inch waist, but one is short while the other tall. Who appears fatter? The short person does, of course. This same optical illusion applies to the nose with a low radix-it appears as it projects further out from the face as compared with the one with the higher radix and not necessarily in an attractive way.
The following photos represent a beautiful result of a corner lip lift and concomitant rhinoplasty in which the radix was raised.
|Work here results in some extra swelling localized to the space between the eyebrows in the sense that it lasts a few days longer. Dr Haworth at the Haworth Institute has a few tricks up his sleeve to accelerate the resolution of the nasal swelling by injecting a dilute mix of Kenalog under the skin (and it is relatively painless) two weeks out. This “turbocharges” the swelling to go away! Of course, the radix can also be augmented with a filler of some sort, such as fat, Radiesse, Juvederm, Aquamid and Artefill.|